OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193)

ICR 202506-2900-007 · OMB 2900-0116 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form VBA-21-4193 NOTICE TO DEPARTMENT OF VETERANS AFFAIRS OF VETERAN OR BENEFICIARY INCARCERATED IN PENAL INSTITUTION Form Modified Repair queued
Form VBA-21-4193 Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193) Form Modified Missing upstream
30-Day (published) 2900-0116.pdf Supplementary Document Uploaded 2025-08-28 Repair queued
30-Day (published) 2900-0116.pdf Supplementary Document Uploaded 2025-08-28 Missing upstream
VA-2025-VACO-0001-0056.pdf Public Comments Uploaded 2025-07-21 Available
VA-2025-VACO-0001-0055.pdf Public Comments Uploaded 2025-07-21 Available
2025-11957, 60-Day FRN (2900-0116, VAF21-4193).pdf Supplementary Document Uploaded 2025-06-27 Repair queued
2025-11957, 60-Day FRN (2900-0116, VAF21-4193).pdf Supplementary Document Uploaded 2025-06-27 Repair queued
2900-0116, Supporting Statement 8-28-25.docx Supporting Statement A Uploaded 2025-08-28 Repair queued
2900-0116, Supporting Statement 8-28-25.docx Supporting Statement A Uploaded 2025-08-28 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
28320 Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193) Form ModifiedNOTICE TO DEPARTMENT OF VETERANS AFFAIRS OF VETERAN OR BENEFICIARY INCARCERATED IN PENAL INSTITUTION
28320 Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193) Form Modified
ICR Details
2900-0116 202506-2900-007
Active 202207-2900-001
VA VBA-COMP-JS
Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193)
Revision of a currently approved collection   No
Regular
Approved without change 12/01/2025
Retrieve Notice of Action (NOA) 08/28/2025
OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.
  Inventory as of this Action Requested Previously Approved
12/31/2028 36 Months From Approved 11/30/2025
9,953 0 7,997
2,488 0 1,999
0 0 0
VA Form 21-4193 is used to gather information from penal institutions about incarcerated VA beneficiaries. When beneficiaries are incarcerated in penal institutions in excess of 60 days after conviction, VA benefits are reduced or terminated. Without this collection of information, VA would be unable to accurately adjust the rates of incarcerated beneficiaries and overpayments would result.
US Code: 38 USC 1505 Name of Law: Payment of pension during confinement in penal institutions
   US Code: 38 USC 5313 Name of Law: Limitation on payment of compensation and dependency and indemnity compensation to persons incarcera
  
None
Not associated with rulemaking
  90 FR 27758 06/27/2025
90 FR 42065 08/28/2025
Yes
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 9,953 7,997 0 1,956 0 0
Annual Time Burden (Hours) 2,488 1,999 0 489 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The respondent burden has increased due to the estimated number of receivables averaged over the past year.
$253,008
No
    Yes
    Yes
No
No
No
No
Dorothy Glasgow 240 205-5190 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/28/2025